Scott D. Miller

• Ph.D.
• Managing Director at International Center for Clinical Excellence

In the last decade, deliberate practice (DP)—a process of formally and systematically training for performance objectives just beyond an individual’s current ability—has emerged as a promising approach for enhancing therapeutic effectiveness. In view of the paucity of prospective studies, an experimental design with a series of challenging clinical...

The Lake Wobegon effect, characterized by individuals’ tendency to overestimate their abilities, is a widely recognized phenomenon across various domains of human performance. This study examined the extent to which Chinese psychotherapists (N = 223), a group culturally influenced by the value of modesty, would demonstrate that effect. It also exam...

Objective: A great deal of research addresses the mental health implications of the COVID-19 pandemic for the general population. Little is known about the implica- tions for mental health of help-seeking outpatients and for the effectiveness of men- tal health services. The present study investigated the mental health and treatment response of hel...

Boswell et al. (2022) persuasively make the case for and propose professional practice guidelines (PPG) for measurement-based care (MBC). Although the evidence for MBC is robust, implementing MBC effectively in practice requires skills and processes not discussed in the PPG. We discuss five problems with the PPG for MBC: The "what's in a name?" pro...

While Routine Outcome Monitoring (ROM) of change and therapeutic alliance is proving to be a promising way to address the issues of drop-out and client deterioration in psychotherapy, at present ROM is infrequently employed in French-speaking contexts. This study aimed at testing psychometric properties of the French versions of two popular and wid...

Conventional mental health treatments do not meet the needs of all who seek help: some consult informal and alternative providers. Researching the use and perceived benefits of these non-conventional sources of help may contribute to understanding help-seeking behavior and inform mental health policy. We explored the experiences of people consultin...

Objectives. The Outcome Rating Scale (ORS) is an ultra-brief self-report scale designed to measure change during psychotherapy. The goal of this study was to test (a) the factor structure of the ORS, (b) the measurement invariance be-tween a clinical and a non-clinical sample, be¬tween pre-therapy and post-therapy assessment (within the clinical sa...

Routine outcome monitoring (ROM) uses standardized measures to both track and inform mental health service delivery. Use of ROM has been shown to improve the outcome of psychotherapy when applied to different types of patients. The present research was designed to determine the reliability and validity of the Outcome Rating Scale (ORS) and the Sess...

Routine outcome monitoring (ROM) is an evidence-based practice that involves regularly measuring treatment progress and alliance/client engagement. ROM use is associated with better client outcomes, so much so that a Canadian Psychological Association (CPA) task force recently recommended that ROM training and supervision be included in CPA’s Accre...

The working alliance has been shown to be a robust predictor of couple therapy outcomes. However, there are still questions regarding the best way to conceptualize and analyze the association between the alliance and outcomes in the couple therapy context. This study presents results from a relatively novel analytic approach for evaluating the alli...

While Routine Outcome Monitoring (ROM) of change and therapeutic alliance is proving to be a promising way to address the issues of drop-out and client deterioration in psychotherapy, at present ROM is infrequently employed in French-speaking contexts. This study aimed at testing psychometric properties of the French versions of two popular and wid...

Psychotherapy is a well-established, efficacious, and fully accepted treatment for mental disorders and psychological problems. Psychotherapy is an interpersonal practice engaging patient values, interests, and personal meanings at every step. Thereby, psychotherapy abounds with moral issues. In psychotherapy ethics, numerous moral issues converge,...

As mental health professionals, we face a choice: limp along with the status quo or work to change it. One can understand how easy it is to feel overwhelmed and discouraged by the enormity of the task, challenges, and risks. Can we really jettison the DSM? Reject so called evidence-based treatment protocols? Stand up to payers and their scientifica...

Psychosocial functioning is considered an important and valued outcome in relation to young people’s mental health as a construct distinct from psychiatric symptomology, especially in the light of an increasing focus on transdiagnostic approaches. Yet, the level of psychosocial functioning is rarely directly asked of young people themselves, despit...

The Session Rating Scale 3.0 (SRS 3.0) is an ultra-brief measure of the therapeutic alliance, frequently used to provide feedback to the clinician during the therapeutic process (Prescott et al. [2017]. Feedback-informed treatment in clinical practice. Reaching for excellence. American Psychological Association (APA). http://www.apa.org/pubs/books/...

Early 2018 we were reminded of the work of experimental psychologist Carol Dweck. She has shown that praising children for traits and qualities (smart, thoughtful, etc.) or for “working hard” led to very different outcomes when it came to both performance and the level of challenges that children took on after they were praised for one or the other...

Objective: Therapist effectiveness has primarily been defined as being the aggregate of the client therapy outcomes within a therapist's caseload. It may seem intuitive that the most skilled therapists are both effective (in the way defined above) and consistent in facilitating positive outcomes across their clients; however, this premise has not...

b>French Validation of two brief Routine Outcome Monitoring (ROM) scales from the PCOMS system : the ORS (Outcome Rating Scale, Miller et al., 2005) designed to assess various dimensions of well-being and progression during care , and the SRS (Session Rating Scale 3.0; Miller et al., 2002) designed to assess dimensions of the therapeutic relationsh...

b>French Validation of two brief Routine Outcome Monitoring (ROM) scales from the PCOMS system : the ORS (Outcome Rating Scale, Miller et al., 2005) designed to assess various dimensions of well-being and progression during care , and the SRS (Session Rating Scale 3.0; Miller et al., 2002) designed to assess dimensions of the therapeutic relationsh...

b>French Validation of two brief Routine Outcome Monitoring (ROM) scales from the PCOMS system : the ORS (Outcome Rating Scale, Miller et al., 2005) designed to assess various dimensions of well-being and progression during care , and the SRS (Session Rating Scale 3.0; Miller et al., 2002) designed to assess dimensions of the therapeutic relationsh...

In recent years, McNamara, and associates Hambrick and Oswald, conducted and published studies which purportedly showed deliberate practice exerts less powerful main effects than presented and popularized in the press, public discourse, and professional circles. Their central aim seemed to be one of correcting a particular misperception, as they su...

In recent years, Macnamara, and associates Hambrick and Oswald, conducted and published studies which purportedly showed deliberate practice (hereafter, DP) exerts less powerful main effects than believed and popularized in the press, public discourse and professional circles. Their central purpose seemed to be one of correcting a misperception, as...

Feedback Informed Treatment (FIT) involves clinicians gathering on-going real time feedback from clients to determine what is working and what is not working in therapy. This chapter provides an overview of feedback informed treatment (FIT), including its historical evolution, guiding principles, and central tenets. It lays out how FIT is applied a...

Measurement-based care (MBC) can improve mental health treatment outcomes and is a priority within the Department of Veterans Affairs (VA). However, to date, MBC efforts within the VA have focused on assessment of psychological symptoms to the exclusion of psychotherapy process variables such as the therapeutic alliance that may predict treatment r...

Little is known about the mechanisms through which routine outcome monitoring (ROM) influences psychotherapy outcomes. In this secondary analysis of data from a randomized clinical trial (Brattland et al., 2018), we investigated whether the working alliance mediated the effect of the Partners for Change Outcome Monitoring System (PCOMS), a ROM syst...

In 2014, Macnamara, Hambrick, and Oswald published a meta-analysis of studies questioning the strength of the association between deliberate practice and performance. In this brief report, the correlation reported by Macnamara et al. (2014) is placed in the context of other well-known associations. Additionally, a re-analysis of the studies include...

Although it is well established that, on average, psychotherapy is effective, outcomes have remained flat for more than five decades. Since the 1990s, the effort to identify "empirically supported treatment" approaches has done little to alter this fact. Even more sobering, studies either fail to show therapists improve with specialized training or...

The Outcome Rating Scale (ORS) is an ultra-brief measure of well-being designed to track outcome in psychotherapy. This research studied the psychometric properties of the ORS in a Spanish clinical sample. One-hundred and sixty-five adult participants from different primary care centers of the city of Barcelona were recruited. The psychometric prop...

The present research studied the psychometric properties of the Outcome Rating Scale (ORS) and Session Rating Scale 3.0 (SRS 3.0) in a Spanish clinical sample. These instruments are ultra-brief measures designed to track outcome, and alliance in psychotherapy, respectively. The psychometric properties of the instruments in the sample were explored...

This chapter talks about steps that can be taken to contribute to the mission of improving psychotherapeutic expertise. Admissions procedures for psychotherapy training programs use challenge tests involving difficult interpersonal interactions to identify those applicants with the greatest potential to help clients. Mental health training programs...

This chapter explores the efforts and subsequent results of one mental health agency seeking to improve its outcomes. It outlines the number of the challenges faced by the agency Calgary Counselling Centre (CCC). The challenges are: static funding for mental healthcare despite increases in clients seeking services; more clients seeking services and...

Clinicians invest a great deal of time, energy, and money in professional growth. They undergo personal therapy, receive ongoing postgraduate supervision, and attend continuing education (CE) events. Deliberate practice (DP) is purposeful and cognitively demanding, going beyond the execution of skills associated with routine work. Expert performanc...

Objective: Three recent meta-analyses have made the claim, albeit with some caveats, that cognitive-behavioral treatments (CBT) are superior to other psychotherapies, in general or for specific disorders (e.g., social phobia). Method: The purpose of the present article was to examine four issues in meta-analysis that mitigate claims of CBT super...

Recent evidence suggests that psychotherapists may not increase in effectiveness over accrued experience in naturalistic settings, even settings that provide access to patients' outcomes. The current study examined changes in psychotherapists' effectiveness within an agency making a concerted effort to improve outcomes through the use of routine ou...

In the field of psychotherapy a “great debate” is raging about how to improve quality and outcome (Wampold, 2001). On one side are those who hold that behavioral health interventions are similar to medical treatments (Barlow, 2004). Therapies work, they believe, because like penicillin they contain specific ingredients remedial to the disorder bein...

Three brief psychotherapy outcome measures were assessed for equivalence. The Rating of Outcome Scale (ROS), a 3-item patient-reported outcome measure, was evaluated for interitem consistency, test-retest reliability, discriminant validity, repeatability, sensitivity to change, and agreement with the Outcome Rating Scale (ORS) and Outcome Questionn...

Objective: Although the working alliance-outcome association is well-established for adults, the working alliance has accounted for 1% of the variance in adolescent therapy outcomes. How the working alliance unfolds in therapy and is modeled in therapy studies may substantially affect how much variance is attributed to the working alliance. Metho...

Objective: Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no large-scale longitudinal study has assessed within-therapist changes in outcomes over time. Method: The present study examined changes in psychothera...

There is a paucity of empirical studies that demonstrate psychotherapy trainees improve at assisting their clients' therapy outcomes over time. We examined whether trainees (i.e., practicum, predoctoral interns, and postdoctoral fellows) improved in their clients' therapy outcomes over time. We examined 114 trainees (i.e., who were trainees for the...

Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no large-scale longitudinal study has assessed within-therapist changes in outcomes over time. Method: The present study examined changes in psychotherapists' outcome...

More than a dozen randomized controlled trials and several meta-analyses have provided strong empirical support for routine outcome monitoring (ROM) in clinical practice. Despite current enthusiasm, advances in implementation, and the growing belief among some proponents and policymakers that ROM represents a major revolution in the practice of psy...

Little empirical research exists about highly effective psychotherapists, and none about the factors that mediate the acquisition and maintenance of superior performance skills (e.g., Ericsson, 1996, 2006; Ericsson, Krampe, & Tesch-Romer, 1993). In the full sample, a 3-level multilevel modeling (Level 1: clients; Level 2: therapists; Level 3: organ...

The current study used multilevel growth mixture modeling to ascertain groups of patients who had similar trajectories in their psychological functioning over the course of short-term treatment. A total of 10,854 clients completed a measure of psychological functioning before each session. Psychological functioning was measured by the Behavioral He...

Objective: The measurement of clinical change via single-group pre-post effect size has become increasingly common in psychotherapy settings that collect practice-based evidence and engage in feedback-informed treatment. Different methods of calculating effect size for the same sample of clients and the same measure can lead to wide-ranging result...

Background: Although ultra-brief outcome and process measures have been developed for individual therapy, currently there are no ultra-brief alliance measures for group therapy. Method: The current study examined 105 clients in group therapy for issues related to substance abuse or with issues related to the substance abuse of a significant other....

Abstract This article reviews the benefits, obstacles, and challenges that can hinder (and have hindered) implementation of routine outcome monitoring in clinical practice. Recommendations for future routine outcome assessment efforts are also provided. Spanning three generations, as well as multiple developed tools and approaches, the four authors...

In 1963, the first issue of the journal Psychotherapy appeared. Responding to findings reported in a previous publication by Eysenck (1952), Strupp wrote of the "staggering research problems" (p. 2) confronting the field and the necessity of conducting "properly planned an executed experimental studies" to resolve questions about the process and ou...

Objective: To evaluate the extent to which a client's successful tobacco quit attempt and subsequent improvement in life satisfaction depend on the quitline counsellor assigned to provide the cessation counselling. Methods: A retrospective review of 2,944 Arizona Smokers’ Helpline client records was conducted on enrolment, follow-up, and programme...

Over the past decade, solution-focused therapy has undergone dramatic growth in interest and popularity. At the same time, there continues to be a dearth of empirical evidence of its purported effectiveness. Moreover, available data indicate that any effectiveness of solution-focused therapy is likely due to both the shared and unique ways the appr...

Outlines the steps to revitalize psychotherapy by harnessing the client's own powers of regeneration and enlisting the client's own perceptions, and thereby making treatment more effective and accountable. This approach advocates for the client's voice in all aspects of therapy and shows how to tailor both relational stances and treatment approache...

Describes the principles of a client-directed, outcome-informed approach to couples therapy. This approach is based on outcome research that identifies 4 factors common to effective therapies: extra-therapeutic or client factors; a positive therapeutic relationship; placebo, hope, and expectancy; and factors related to models and techniques, which...

On reflection, the term positive psychology merits serious consideration as an oxymoron. Setting aside the many subdisciplines that comprise the grand field of psychology, the tone of professional discourse, particularly as it applies to clinical assessment and intervention, has been and remains decidedly negative. The dominant language of therapy...

The Rewind TechniqueEvolution of Rewind and Evaluation of the Existing EvidenceBackground to PRNsEvaluation of “Rewind” Using the PRNThe Challenge of EvidenceWhat the PRN Tells Us That the RCT Does NotPragmatic SolutionsReferences

Many researchers accept that trauma-focused treatments are superior to non-trauma focused treatments for Post-Traumatic Stress Disorder (PTSD). However, Benish, Imel, and Wampold (2008) recently published a meta-analysis of clinical trials directly comparing 'bona fide' PTSD treatments that failed to reject the null hypothesis that PTSD treatments...

This paper proposes that psychotherapy has affinities with TCM that may be useful for our understanding of both. These affinities center on the way in which the doctor/patient relationship is viewed and the ways in which treatment is understood. Based on affinities between psychotherapy and TCM the paper further proposes that psychotherapy outcome...

This volume continues to highlight the common factors and honors the pivotal role of clients in successful psychotherapy. As seen, this volume also documents a major innovation in psychotherapy: the development and use of monitoring and feedback systems. When used routinely, outcome measurement and management mobilize the common factors and facilit...

Continuous client feedback offers great promise for improving treatment outcomes. Because of their feasibility for everyday clinical use, the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) enjoy popularity in the US and have been translated in various languages, including Dutch. The present study investigated the psychometric propert...

To estimate the relative efficacy of alcohol use disorder treatments, the authors meta-analyzed studies that directly compared 2 bona fide psychological treatments. The authors accommodated problems with the inclusion of multiple treatment comparisons by randomly assigning a positive/negative sign to the effect size derived from each comparison and...

A critical review of three articles reveals flawed empirical evidence underpinning the case for integrating pharmacotherapy and psychotherapy. Medical model dominance favors biology in a diathesis/ stress framework, creating myths of valid diagnosis, underlying biological causes, and targeted pharmacological treatments. Meanwhile, a for-profit phar...

A meta-analysis was conducted to determine whether differences in efficacy exist among treatment approaches applied to youth. Included were all studies published between 1980 and 2005 involving participants 18 years of age or younger with diagnoses of depression, anxiety, conduct disorder, and attention-deficit/hyperactivity disorder that contained...

Clients of the best therapists improve at a rate at least 50 per cent higher and drop out at a rate at least 50 per cent lower than those of average clinicians. What is the key to superior performance? Are 'supershrinks' made or born? Is it a matter of temperament or training? Have they discovered a secret unknown to other clinicians or are their s...

Policy makers and payers are insisting that to be paid, therapists must "deliver the goods." Concurrently, there is a worldwide movement to involve consumers in their care. Consequently, the measurement of change, from the client's perspective, has become an important topic. Unfortunately, no self-report outcome measure has been available for child...